Health (Wales) Bill

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Chris Grayling: In framing such provisions, one always has to think about the unexpected as well as the expected. Let us suppose that a strongly nationalist Administration were elected in Wales and chose to use their management of the NHS to propagate an anti-UK separatist agenda. They could use the provisions on the preparation and publication of reports and their content to require CHCs to behave in a way that did not diametrically oppose that agenda. To provide one avenue of reporting that is independent of the Assembly, and of prescription by the Assembly, would at least provide a safeguard against such an extreme and unexpected situation. While that is unlikely, it is surely a consideration when we are trying to guarantee the independence of such bodies.

Mr. Touhig: I can imagine the nationalists being extreme in every way possible, but not even in my wildest nightmares can I imagine them being in a position to enact some of what the hon. Gentleman suggested.

My hon. Friend the Member for Cardiff, Central referred to the Audit Commission. We have bodies

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established in statute, with functions independent of and at arm's length from Government, that can inspect and audit what we do on the delivery of public services. That is the case in the health service, and it will be provided for in legislation that will come before the House before long.

It is important that we bear in mind that the function of the CHCs is surely to scrutinise NHS bodies, not to report explicitly in the way that the amendment would make them do. We all know from our constituency surgeries that when someone comes up against a problem in the health service—a failure to provide them with the service that they expect—they want immediate action. We, as Members of Parliament, write to Ministers to raise the issue, which gets into the Western Mail; God only knows what the hon. Gentleman would do for his lines if he did not have articles in the Western Mail to report.

The Committee should recognise that the amendment would create unnecessary additional work for CHCs. They will not be prevented from raising any matter in an annual report if they think it appropriate, but the amendment is unnecessary. I hope that the hon. Gentleman feels that we have fully debated the amendment and that he has had the opportunity to raise some important points. I hope, however, that I have persuaded him that the amendment is unnecessary because the Bill includes provisions to allow CHCs to report as widely as they need to on the delivery of the health service in Wales.

Mr. Evans: We have had an important and significant debate on the amendment. I thank the hon. Members for Cardiff, Central and for Cardiff, North for their important contributions. It is important that we get the Bill right before it goes to another place, where I am sure that the words of the Committee will be read with great interest and some amendments may be tabled. Just as the hon. Member for Brecon and Radnorshire was shocked that the Government had tabled no amendments, we may all be shocked and dismayed if the Government do not table some amendments in another place to try to improve their legislation, especially once they have listened to what we have to say and when they have received further representation from bodies and individuals affected by the NHS in Wales.

The hon. Member for Cardiff, Central says that CHCs do not have sufficient resources and that the requirement proposed in the amendment would be expensive. I hope that they will be adequately funded in future so that they can do their jobs properly. It would be wholly wrong if their funding were insufficient for them to carry out the duties that we currently place on them, irrespective of whether the amendment ever reaches the statute book in this form or some other.

The hon. Member for Cardiff, Central mentioned the Audit Commission, which is independent, widely respected and publishes some useful reports. We hope that action will flow from that. He said that it would be expensive for the 22 health boards to produce reports and that the money could be better spent. Money spent on health care is always money well spent, as long as it is effectively spent. Efficient

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expenditure is important, and that is where CHCs come in. The Government are spending significant sums of money on the national health service, but we know that there are still real problems. That is why a report from each of the health boards would come in handy and give us an overall picture of the quality of service in Wales.

To pick up the point raised by the hon. Member for Brecon and Radnorshire, a report might include some individual cases that reflect an overall pattern of deficiency or improvements in service. If there are areas of expertise in any of the 22 local health trusts, they may want to shout about those, too. A report could provide an important function in allowing a health trust to set out what it does and help other health trusts to roll out best practice in their areas.

The hon. Member for Cardiff, North made an important point about AIDS. That may not be the best example, but we know that it has huge resource implications for the NHS because of the growing number of people being diagnosed as HIV positive. I do not know whether there may be a significant increase in some areas within the 22 health boards and none in other areas of Wales.

I could imagine that Cardiff would have a larger percentage per head of population affected than any other part of Wales; indeed, I suspect that that would be normal. In certain parts of west Wales, I would not be surprised to learn that the figures are, and have always been, few in comparison with Cardiff and London. However, an annual report in an individual area could highlight deficiencies, perhaps without going into too much specific detail. A CHC might raise an issue in response to a growing number of AIDS patients in Cardiff, for example. Other specialties and services might be shown to be lacking in funds or cut back simply because of the budgetary implications of AIDS.

Chris Grayling: Does my hon. Friend share my disappointment at the Minister's response, particularly his lack of understanding that the amendments are designed to strengthen the independence of CHCs in a Bill that creates too much linkage between the actions, responsibilities and remits of the CHCs and the ability of the Assembly to take decisions affecting them? The amendment is one part of a jigsaw puzzle aimed at strengthening the hand of the CHCs in scrutinising people who are responsible for the health service and for legislation that might follow.

Mr. Evans: I am mostly disappointed by any of the Minister's suggestions and I am glad that you,

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Mr. Griffiths, clarified that none of the amendments are wrecking amendments. They are designed to improve the Bill, probe the Government and clarify the meaning of the provisions. Some legalese is evident and it is important to tackle what the Bill is about. The whole Committee wants the NHS improved from its current level of provision.

The Minister said in his response to me that the amendment would lead to a duplication of duties. Doubtless the CHCs would draw on other reports for their information to underpin their view that the level of quality in a particular area was either superior or inferior to others. The duplication should not, however, overly worry us as long as the other reports are incorporated in the CHCs' annual reports. They might also incorporate some of reports requested under sub-paragraphs (h) and (i) in paragraph 2 of new schedule 7A.

My hon. Friend the Member for Epsom and Ewell described a worst-case scenario; it is always important to do so when reflecting on proposed legislation. If the nationalists took over, that would be the worst-case scenario that members of this Committee could possibly imagine. The nationalists would promote certain policies within an independent NHS within an independent Wales; that should send shudders down our very spines. In considering such worst-case scenarios, it is right that the Bill ensures that CHCs have the independence of mind to investigate certain topics without fear of what the National Assembly for Wales might say. The Assembly might be irritated by their reports and put pressure on CHCs to stop reporting.

The Minister says that the CHCs are there to scrutinise, not to report. I completely disagree; they are there to scrutinise and report. We have already heard about the many reports that CHCs already produce.

The Minister was gracious in saying that I had made some good points in today's debate. I should like to probe further how best to ensure the independent scrutiny of CHCs and their ability to produce a comprehensive report without fear of direction elsewhere by the Welsh Assembly. I shall not divide the Committee on that today, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Four o'clock.

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The following Members attended the Committee:
Griffiths, Mr. Win (Chairman)
Ainger, Mr.
David, Mr.
Edwards, Mr. Huw
Evans, Mr.
Francis, Dr.
Grayling, Chris
Havard, Mr.
Jones, Mr. Jon Owen

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Morgan, Julie
Robertson, Hugh
Ruane, Chris
Taylor, Ms
Touhig, Mr.
Wiggin, Mr.
Williams, Hywel
Williams, Mr. Roger

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Prepared 10 December 2002